One of the major contributions of clinical psychology to the
helping professions has been the scientist practitioner model. This model,
first developed at the Boulder Conference in 1949 (Petersen, 2007), stipulates
that clinicians both rely on empirical evidence to guide their choice of
treatments and contribute towards the research endeavour (Jones & Mehr,
2007). The primary aim of the Boulder Conference was to develop guidelines for
the training of clinical psychologists, setting a standard approach, given the
diversity of training curriculum in the United States at the time. This conference
was successful in ensuring that the majority of clinical training programmes
include astrong research dimension.
Despite this contribution there is a
growing consensus that the ideals of the Boulder Conference have failed to be
realized (Chwalisz, 2003; Stricker, 2002, 2003). Of particular concern is an emphasis
on the use of randomized controlled trials as the primary research methodology.
This method relies on a uniform sample of clients and a strict adherence to
techniques and the timing of sessions, circumstances that do not mirror the
complexity of the real world of clinical practice (Rothwell, 2005). There is
also increasing recognition that a reliance on manualized treatments can fail
to recognize the critical role of the therapeutic relationship in determining
efficacy (Wampold et al., 1997), a factor that has been found to be responsible
for a much as 30 percent of variance (Lambert & Barley, 2001). In addition,
manuals do not adequately consider the role of the clinician in guiding the
client to recovery (Duncan & Miller, 2005), including dealing with common
obstacles, such as ‘non-compliance’, clinical impasses or difficulties between
therapist and client (Pachankis & Goldfried, 2007; Persons &
Silberschatz, 1998).
Sackett, Strauss, Richardson, Rosenberg and Haynes’s
(2000) tripartite model of evidence based medicine allows for a greater
integration of science and practice, by recognizing the role of clinical wisdom
in the implementation of treatment techniques. These notions are far from
novel, with Kuhn (1962) proposing that scientific theory is insufficient and
that ‘puzzle solving’ was required for a scientist to be considered as
competent. The American Psychological Society (APA) (2006) also recognizes this
approach, stating that practitioners need to consider research findings,
clinical expertise and patient characteristics in decision making. Clinical
expertise is seen to include self-reflection, interpersonal skills and patient
characteristics, including their unique strengths, cultural context and
preferences.
The APA also recommends greater methodological diversity in
research, with methods based on the research question being asked. These
questions include the exploration of how clinicians make decisions in a
sensitive and flexible manner, the effects of race and culture on the treatment
process, how the psychologist manages the therapeutic relationship and its
connection to outcomeand more. Norcross, Beutler and Levant (2005) mirror this
recommendation in their important edited book, Evidence-based practices: Debate
and dialogue on the fundamental questions. The authors represented call for
greater recognition of a host of methodologies, including single-participant designs
(Hurst & Nelson-Gray, 2005), qualitative research (Hill, 2005) and process
studies(Greenberg & Watson, 2005). Critics from counselling and family
therapy (Chwalisz, 2003;Sexton, Kinser, & Hanes, 2008) argue that such
endeavours imply an expansion of what is considered evidence. From the APA’s
perspective, however, this simply implies a more faithful and open-minded
interpretation of the existing definition.
Process research can play a critical role in supporting
the further integration of science and clinical practice. Greenberg and Watson
(2005) argue for this eloquently, stating that the interplay of therapist and
patient variables needs to be studied in all its complexity if we are to
understand the means by which outcomes are established. This is reinforced by
Duncan and Miller’s (2005) statement that ‘the manual is not the territory,’ a reference to Bateson (1972) and an assertion that structured
protocols do not describe the dynamic of psychotherapeutic change.
Excerpt from paper: Link
Rhodes, P. (2011). Why we need process research in Clinical Psychology. Journal of Clinical Child Psychology and Psychiatry
No comments:
Post a Comment